CONTINUING EDUCATION IN HONOR OF NORMAN TRIEGER, DMD, MD
|
|
- Daniela Hawkins
- 6 years ago
- Views:
Transcription
1 CONTINUING EDUCATION IN HONOR OF NORMAN TRIEGER, DMD, MD Essentials of Airway Management, Oxygenation, and Ventilation: Part 2: Advanced Airway Devices: Supraglottic Airways M. B. Rosenberg, DMD,* J. C. Phero, DMD, and D. E. Becker, DDS *Professor of Oral Maxillofacial Surgery, Head, Division of Anesthesia and Pain Control, and Associate Professor of Anesthesia, Tufts University Schools of Dental Medicine and Medicine, Boston, Massachusetts, Professor Emeritus Anesthesiology, College of Medicine, University of Cincinnati Medical Center, Cincinnati, Ohio, and Associate Director of Education, General Dental Practice Residency, Miami Valley Hospital, Dayton, Ohio Offices and outpatient dental facilities must be properly equipped with devices for airway management, oxygenation, and ventilation. Part 1 in this series on emergency airway management focused on basic and fundamental considerations for supplying supplemental oxygen to the spontaneously breathing patient and utilizing a bagvalve-mask system including nasopharyngeal and oropharyngeal airways to deliver oxygen under positive pressure to the apneic patient. This article will review the evolution and use of advanced airway devices, specifically supraglottic airways, with the emphasis on the laryngeal mask airway, as the next intervention in difficult airway and ventilation management. The final part of the series (part 3) will address airway evaluation, equipment and devices for tracheal intubation, and invasive airway procedures. Key Words: Airway management; Ventilation; Devices; Supraglottic airways; Laryngeal mask airways. This article reviews the evolution and use of advanced airway devices, specifically supraglottic airways (SGAs), with the emphasis on the laryngeal mask airway (LMA), as the next intervention in difficult airway and ventilation management after bag-mask ventilation has been attempted. Management of the unexpected difficult airway during deep sedation and general anesthesia remains the most important aspect in avoiding mortality and morbidity because of the severe consequences of inadequate ventilation and oxygenation, especially in out-of-operating-room locations. 1 There are several predictors and tests that might alert the clinician to anticipate the possibility of a difficult airway, which will be discussed and reviewed in the third Received June 9, 2014; accepted for publication June 10, Address correspondence to Dr Daniel E. Becker, Associate Director of Education, General Dental Practice Residency, Miami Valley Hospital, One Wyoming St, Dayton, Ohio 45409; debecker@ mvh.org. paper in this series. Thankfully for patient safety, most airway difficulties are overcome with relatively straightforward airway maneuvers, devices, and techniques, but it is the training and experience of the operator that often makes the difference when airway and ventilation management becomes difficult. The American Society of Anesthesiologists (ASA) Difficult Airway Management Algorithm, a part of the ASA Practice Guidelines, has become the gold standard in addressing the urgent response to the inability to oxygenate and ventilate. 2 This program was driven by the fact that airway complications were associated in the ASA Closed Claims Database as a leading cause of death or permanent neurologic injury during general anesthesia. 3 The guidelines are dynamic, and have changed over the years to recognize newer concepts with the introduction of newer airway devices. It is very important to note in the ASA guidelines that the use of LMA has been replaced with the generic term SGA. This includes the LMA and other supraglottic devices. Anesth Prog 61: ISSN /14 Ó 2014 by the American Dental Society of Anesthesiology SSDI (14) 113
2 114 Advanced Airway Devices: Supraglottic Airways Anesth Prog 61: Figure 1. American Dental Society of Anesthesiology unconscious patient airway algorithm. Building on the ASA guidelines, the American Dental Society of Anesthesiology, the American Dental Association, and the American Association of Oral and Maxillofacial Surgeons have incorporated the use of SGA as an advanced airway device in their emergency airway rescue curriculum and team emergency simulation workshops. (Figure 1.) SUPRAGLOTTIC AIRWAYS An SGA is any airway device that sits outside the larynx and forms a seal around it, permitting increased ventilation pressure between 20 and 40 cm H 2 O and reducing the chance of gastric distention that can be encountered during face-mask ventilation. Although intubation continues as the gold standard for airway management and protection from aspiration, correct SGA use requires less expertise and training than endotracheal intubation. The SGA combines the features of the face mask with those of the endotracheal tube and permits ventilation with more pressure than is possible with face-mask ventilation, as face-mask ventilation may permit drop of the epiglottis, partially or completely blocking the glottis, when ventilation pressure exceeds 20 cm H 2 O. With occlusion of the glottis, the volume delivered by the resuscitation bag then enters and pressurizes the stomach, leading to the possibility of emesis and aspiration. (Figure 2.) The initial SGA was the esophageal obturator airway, which evolved into the Combi-Tube. Both of these devices had problems related to confirming correct placement, esophageal injury, and limited size availability. The King LTS-D evolved from these devices and is currently an accepted SGA in the prehospital setting. This device has received US Food and Drug Administration approval but is currently not endorsed by the Figure 2. Positioning of oropharyngeal airway. (A) Oropharyngeal airway does not seal glottis and requires caution when bag mask pressures exceed 20 cm H 2 O. (B) Epiglottis drops down over glottis when excessive bag mask pressure is used, potentially pressurizing the stomach. American Heart Association as an advanced airway during cardiopulmonary resuscitation (CPR). Since 1983 the elective use of the LMA has revolutionized the practice of anesthesia as an alternative to mask ventilation and endotracheal intubation. The introduction of the LMA is the single most important advance in airway devices over the last 25 years, and the LMA has been used worldwide in over 200 million patients. Although endotracheal intubation has been and continues to be the standard to secure the airway during urgent or emergent situations, the use of an SGA is extremely beneficial as a primary airway rescue device. Rapid control of the airway is critical in airway rescue for patients with acute apnea and/or airway obstruction. SGAs have totally revolutionized airway rescue as a first alternative after difficult mask ventilation and endotracheal intubation, failure or difficulty with the simple airway rescue maneuvers, or inability to perform adequate bag-valve-mask ventilations. The ease and versatility of use of the SGA still make it a crucial management tool for practitioners accomplished in
3 Anesth Prog 61: Rosenberg et al. 115 intubation and also for those who have limited intubation skills. Many studies validate the use of SGA in providing an adequate airway conduit to overcome apnea and soft tissue airway obstruction in the unconscious patient. SGA is a lifesaving maneuver when intubation of the trachea is not an option or not possible within the American Heart Association recommendation of 30 seconds, especially when patient comorbidities may include obesity, bronchospasm, and/or emphysema, which potentially would create bag-mask ventilation pressures greater than 20 cm H 2 O. To allow appropriate team management of ventilation pressures, resuscitation bags with manometers are beneficial. (Figure 3.) Additionally, if the patient is pulseless, the SGA optimizes CPR chest compressions, because once the SGA is placed, there is no need for a pause in the compressions to allow time for ventilations. The increased efficiency in compressions over each 2-minute interval is as follows: (a) 200 with the SGA versus 150 with the mask and (b) not stopping 5 times during each 2-minute interval, which otherwise drops coronary and cerebral perfusion pressure to zero and requires 3 5 compressions just to regain perfusion pressures. The original, classic design of the LMA was revolutionary, permitting a seal directly over the glottis. (Figure 4.) However over time, use of the device revealed that (a) the tip could be flipped forward or backward, resulting in a poor airway seal over the glottis; (b) the practitioner needed to properly inflate the LMA to achieve a positive seal of the glottis; (c) if a patient bit down with the LMA in place, the LMA could become occluded; and (d) if bagmask ventilation prior to placement of the LMA used excessive pressures resulting in pressurization of gastric contents, the LMA did not permit release of the gastric pressure, and the patient would still be at risk for aspiration. Evolution of the LMA has led to 4 relatively new single-use SGAs that now possess a gastric port to decompress the pressure in the patient s gastrointestinal system and provide solutions to the above limitations of the original LMA. These newer SGAs are recommended for the office airway emergency. Gastric venting is an important addition to the classic SGAs, as during unsuccessful attempts with a bag-valve-mask system because of anatomical factors or the need to generate high inspiratory pressures over 20 cm H 2 O, air is forced into the gastrointestinal tract, leading to compression of Figure 3. Exemplary resuscitation bag manometers. Resuscitation bag manometers provide 3 colored zones indicating pressure being delivered during bag ventilation: (a) 0 20 cm H 2 O (green), safe for bag mask ventilation with or without oropharyngeal or nasopharyngeal airways; (b) cm H 2 O (yellow), safe for bag ventilation with advanced airway (SGA or endotracheal tube); and (c).40 cm H 2 O (red) unsafe pressure due to potential barotrauma.
4 116 Advanced Airway Devices: Supraglottic Airways Anesth Prog 61: Figure 5. Comparison of classic LMA (left side) versus i-gel (right side). Four beneficial features of i-gel not found in the classic LMA: (a) does not require air inflation to seal over the glottis; (b) tip does not flex forward or backward preventing seal over the glottis; (c) vents gastric pressure if prior bag mask ventilation has pressurized the stomach; and (d) has a bite block to prevent loss of airway if patient bites down during return to consciousness while still needing airway management and ventilation assistance. Figure 4. Final positioning of supraglottic airway. (A) Laryngeal mask airway (LMA) slightly moved down to show direct seal over glottis, permitting pressures of cm H 2 O without pressurizing the stomach. Note that the practitioner must always verify that the device is past the base of the tongue to have adequate depth for creating a seal over the glottis. (B) Bronchoscope visualization of LMA centered over and sealing patient s glottis. easier insertion. The skill set required to master SGA placement is relatively easy to acquire and retain. 5,6 They are all disposable, one-time use and come in adult and some pediatric sizes. Some of these devices also have the capacity to be used as a conduit for blind endotracheal intubation. 7 There is no need for laryngoscopy to place an SGA. (Figure 5.) The American Heart Association via its world-recognized programs of advanced cardiovascular life support 8 supports the use of SGAs as a reasonable alternative to endotracheal intubation. An SGA can be inserted successfully without interrupting chest compression, and its use has been validated in numerous studies. 9 The correct placement of advanced airway devices allows for more chest compressions (200 vs 150) per 2-minute cycle, and ventilations become asynchronous rather that synchronous with them. The placement of an advanced airway allows for effective, high-quality CPR. The correct placement of any advanced airway device is confirmed by auscultation and observation of chest rise and the detection of end-tidal CO 2. the lung fields and, often, vomiting. SGAs are also useful when attempts at endotracheal intubation fail to establish an airway. 4 As opposed to the older SGAs, the newer ones tips are reinforced to prevent folding and their bodies are more rigid to prevent rotation and allow for LMA Supreme The LMA Supreme (LMA of North America) is a fixedcurve device designed for easier insertion, gastric access,
5 Anesth Prog 61: Rosenberg et al. 117 rapid establishment of a safe airway and an integrated bite absorption area to prevent airway occlusion. This LMA has a bite block and reinforced tip. The LMA cuff must be inflated to guarantee a seal. i-gel LMA The i-gel (Intersurgical) is a noninflatable SGA that is manufactured from medical grade thermoplastic elastomer that creates an anatomical seal of the laryngeal, perilaryngeal, and pharyngeal structures after placement. It also has an integrated bite block and gastric vent. Some studies indicate that this device may be placed more quickly than others. 11,12 The i-gel is recommended in the American Dental Society of Anesthesiology emergency management team simulation workshops for the practitioner who does not have the clinical experience to intubate the trachea and seldom uses an SGA. The i-gel (a) does not require air inflation to seal over the glottis; (b) has a tip that does not flex forward/ backward, which can prevent a seal over the glottis; (c) can vent gastric pressure if bag-mask ventilation has pressurized the stomach; and (d) has a bite block to prevent loss of airway if the patient bites down. Anecdotal authors experience indicates that because this device does not require inflation of a glottis cuff, the device can be placed as quickly as an oropharyngeal airway and permits all the benefits gained from an advanced airway. (Figure 6.) Figure 6. i-gel supraglottic airway. (A) i-gel slightly moved down to show correct placement for seal over glottis permitting pressures up to 40 cm H 2 O without pressurization of stomach during ventilation. (B) i-gel patient placement with maxillary central incisors at the black line. separation of the respiratory and alimentary tracts, and an integral bite block. 10 The Supreme consists of an elliptical airway conduit with an integrated gastric venting tube. The bite block, situated at the proximal end, lies between the central incisors when the mask is properly positioned. The LMA cuff must be inflated to provide a seal. King LTS-D The King LTS-D (Ambu) differs from the previously discussed gastric-venting LMAs, as it is a true SGA device that does not provide a direct seal over the glottis. It is a double-lumen, silicone tube with a large oropharyngeal blocking cuff and smaller esophageal blocking cuff that lies in the esophagus below the glottis. The ventilation port is situated between these cuffs. It has become very popular for first responders in the emergency medical services/emt community because of its ease of insertion. 13 AuraGain LMA The AuraGain (Ambu) is Ambu s third- generation LMA. It provides airway management control by integrating gastric venting access and intubation capability in an anatomically curved single-use device that facilitates CONCLUSION As novel and innovative as these airway management and rescue devices are, one must remember that their role always must be as part of an emergency airway algorithm that is a stepwise progression that goes
6 118 Advanced Airway Devices: Supraglottic Airways Anesth Prog 61: logically and rapidly through decision points. SGAs have a proven role in airway rescue in unanticipated respiratory issues. However, there is no single fail-safe technology in airway management that can overcome every problem. There is no doubt that the devices are only as good as the clinical judgment of the provider and his or her training and experience. The introduction of any critical airway rescue device must be rehearsed and practiced to assure that the device will, in fact, make the difference in patient safety and outcome. REFERENCES 1. Metzner J, Posner Kl, Domino KB. The risk and safety of anesthesia at remote locations: the US closed claims analysis. Curr Opin Anaesthesiol. 2009;22: Practice guidelines for the management of the difficult airway: an updated report by the American Society of Anesthesiologists Task Force on management of the difficult airway. Anesthesiology. 2013;118: Metzner J, Posner KL, Lam MS, Domino KB. Closed claims analysis. Best Pract Res Clin Anesthesiol. 2011;25: Hung O, Murphy M. Unanticipated difficult intubation. Curr Opin Anaesthesiol. 2004;17: Pennant JH, Walker MB. Comparison of the endotracheal tube and laryngeal mask in airway management by paramedical personnel. Anesth Analg 1992;74: Vertongen VM, Ramsay MP, Herbison P. Skills retention for insertion of the Combitube and laryngeal mask airway. Emerg Med. 2003;15: Benumof JL. Use of the laryngeal mask airway to facilitate fiberscope aided tracheal intubation. Anesth Analg. 1992;74: Neumar R, Otto C, Link M, et al. Part 8: adult advanced cardiovascular life support: 2010 guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122:S729 S Dorges V, Wenzel V, Knacke P, Gerlach K. Comparison of different airway management strategies to ventilate apneic, nonpreoxygenated patients. Crit Care Med. 2003;31: Verghese C, Ramaswamy B. LMA-Supreme, a new single-use LMA with gastric access: a report on its clinical efficacy. Br J Anaesth. 2008;101: Richez B, Saltel L, Banchereau F. A new single use supraglottic airway device with a noninflatable cuff and an esophageal vent: an observational study of the i-gel. Anesth Analg. 2008;106: Castle N, Owen R, Hann M, Naidoo R, Reeves D. Assessment of the speed and ease of insertion of three supraglottic airway devices by paramedics: a manikin study. Emerg Med J. 2011;27: Bein B, Scholz J. Supraglottic airway devices. Best Pract Res Clin Anaesthesiol. 2005;19: CONTINUING EDUCATION QUESTIONS 1. According to the American Dental Society of Anesthesiology unconscious patient algorithm, a supraglottic airway should be considered: A. initially in all unconscious patients B. initially in unconscious patients with apnea C. when attempts at bag-valve-mask ventilation are unsuccessful D. when attempts at bag-valve-mask ventilation with an oropharyngeal airway are unsuccessful 2. Use of a supraglottic airway will allow the safe use of ventilation pressures of up to how many centimeters of water? A B C D Which of the following features of various supraglottic airways is unique to the i-gel device? A. No requirement for cuff inflation B. Gastric venting is provided C. Does not require laryngoscopy for insertion D. Contains a bite block 4. Correct placement of a supraglottic airway can be confirmed by which of the following? (1) auscultating breath sounds (2) pulse oximetry (3) chest rise upon ventilation A. 1 and 2 B. 1 and 3 C. 2 and 3 D. 1, 2, and 3
The Laryngeal Mask and Other Supraglottic Airways: Application to Clinical Airway Management
The Laryngeal Mask and Other Supraglottic Airways: Application to Clinical Airway Management D. John Doyle MD PhD FRCPC Department of General Anesthesiology Cleveland Clinic Foundation 9500 Euclid Avenue
More informationAIRWAY MANAGEMENT AND VENTILATION
AIRWAY MANAGEMENT AND VENTILATION D1 AIRWAY MANAGEMENT AND VENTILATION Basic airway management and ventilation The laryngeal mask airway and Combitube Advanced techniques of airway management D2 Basic
More informationBlind Insertion Airway Devices (BIAD)
P03 Procedures 2017-05-12 All ages Office of the Medical Director Blind Insertion Airway Devices (BIAD) Primary Intermediate Advanced Critical From AIRWAY & BREATHING MANAGEMENT or AIRWAY OBSTRUCTION Yes
More informationDIFFICULT AIRWAY MANAGMENT. Dr.N.SANTHOSH KUMAR MD ANESTHESIA (2 nd Yr)
DIFFICULT AIRWAY MANAGMENT Dr.N.SANTHOSH KUMAR MD ANESTHESIA (2 nd Yr) AIRWAY MANAGEMENT AND MAINTAINING OXYGENATION ARE THE FUNDAMENTAL RESPONSIBILITIES OF ANY BASIC DOCTOR. TO MANAGE A DIFFICULT AIRWAY,
More informationRecent Advances in Airway Management HA Convention 2014
Recent Advances in Airway Management HA Convention 2014 Dr. HK Cheng Chief of Service (Dept. of Anaesthesia & OT) Service Director (Ambulatory Surgery Centre) Tseung Kwan O Hospital Recent Advances in
More informationAirway Management Essentials Self-Study Guide
Airway Management Essentials Self-Study Guide Fourth Quarter 2010 Self-Study Guide Learning Objectives Cognitive Domain 1. Describe the various conditions that cause concern during treatment in the field
More informationAdult Advanced Cardiovascular Life Support. Emergency Procedures in PT
Adult Advanced Cardiovascular Life Support Emergency Procedures in PT BLS Can be learned & practiced by the general public Includes: CPR First Aid (e.g. choking relief) Use of AED ACLS Used by healthcare
More information1 Chapter 40 Advanced Airway Management 2 Advanced Airway Management The advanced airway management techniques discussed in this chapter are to
1 Chapter 40 Advanced Airway Management 2 Advanced Airway Management The advanced airway management techniques discussed in this chapter are to introduce the EMT-B student to these procedures only. In
More informationOther methods for maintaining the airway (not definitive airway as still unprotected):
Page 56 Where anaesthetic skills and drugs are available, endotracheal intubation is the preferred method of securing a definitive airway. This technique comprises: rapid sequence induction of anaesthesia
More informationChapter 40 Advanced Airway Management
1 2 3 4 5 Chapter 40 Advanced Airway Management Advanced Airway Management The advanced airway management techniques discussed in this chapter are to introduce the EMT-B student to these procedures only.
More informationAdvanced Airway Management. University of Colorado Medical School Rural Track
Advanced Airway Management University of Colorado Medical School Rural Track Advanced Airway Management Basic Airway Management Airway Suctioning Oxygen Delivery Methods Laryngeal Mask Airway ET Intubation
More informationWaitin In The Wings. Esophageal/Tracheal Double Lumen Airway (Combitube ) Indications and Use for the Pre-Hospital Provider
Waitin In The Wings Esophageal/Tracheal Double Lumen Airway (Combitube ) Indications and Use for the Pre-Hospital Provider 1 CombiTube Kit General Description The CombiTube is A double-lumen tube with
More informationGeneral Medical Procedure. Emergency Airway Techniques (General Airway Protocol)
General Medical Procedure Appropriate airway management is often the most important intervention a prehospital care provider makes, as ensuring adequate oxygenation and ventilation is crucial to the survival
More informationEquipment: NRP algorithm, MRSOPA table, medication chart, SpO 2 table Warm
NRP Skills Stations Performance Skills Station OR Integrated Skills Station STATION: Assisting with and insertion of endotracheal tube (ETT) Equipment: NRP algorithm, MRSOPA table, medication chart, SpO
More informationDifficult Airway. Victor M. Gomez, M.D. Pulmonary Critical Care Medicine Medical City Dallas Hospital
Difficult Airway Victor M. Gomez, M.D. Pulmonary Critical Care Medicine Medical City Dallas Hospital Difficult Airway Definition Predicting a difficult airway Preparing for a difficult airway Extubation
More informationNicolette Mosinski MPAS, PA-C
Nicolette Mosinski MPAS, PA-C 1. Impaired respiratory effort 2. Airway obstruction Observe patient for detection Rate Pattern Depth Accessory muscle use Evidence of injury Noises Silent manifestations
More informationLMA Supreme Second Seal. Maintain the airway. Manage gastric contents. Meet NAP4 recommendations.
LMA Supreme Second Seal Maintain the airway. Manage gastric contents. Meet NAP4 recommendations. A proven double seal The importance of the Second Seal (oesophageal seal) is significant: it can minimise
More informationComparison of the Berman Intubating Airway and the Williams Airway Intubator for fibreoptic orotracheal intubation in anaesthetised patients.
Title Comparison of the Berman Intubating Airway and the Williams Airway Intubator for fibreoptic orotracheal intubation in anaesthetised patients Author(s) Greenland, KB; Ha, ID; Irwin, MG Citation Anaesthesia,
More informationIntroducing the Fastrach-LMA. Prepared by Jim Medeiros, NREMT-P Regional Field Coordinator Lord Fairfax EMS Council
Introducing the Fastrach-LMA Prepared by Jim Medeiros, NREMT-P Regional Field Coordinator Lord Fairfax EMS Council Objectives Review Anatomy of the Upper Airway Review LFEMSC LMA Protocol Discuss Indications
More informationPortage County EMS Annual Skills Labs
Portage County EMS Annual Skills Labs Scope: Provide skills labs for all Emergency Medical Responders and First Response EMTs to assure proficiency of skills and satisfy the Wisconsin State approved Operational
More informationADVANCED AIRWAY MANAGEMENT
The Advanced Airway Management protocol should be used on all patients requiring advanced airway management procedures. This protocol is divided into three sections the Crash Airway Algorithm, the Rapid
More informationAdvanced Airway Management
CHAPTER 37 Advanced Airway Management Airway Anatomy and Physiology Review Respiratory System: The Airway Respiratory System (Supine) Physiology: Factors of Adequate Breathing Functioning brainstem Open
More informationPROBLEM-BASED LEARNING: Airway Management in Remote Area
PROBLEM-BASED LEARNING: Airway Management in Remote Area Dr Eric You-Ten, MD PhD FRCPC Assistant Professor Department of Anesthesia Mount Sinai Hospital CASE: Airway Nightmare in A Remote Location OBJECTIVES:
More informationAirway/Breathing. Chapter 5
Airway/Breathing Chapter 5 Airway/Breathing Introduction Skillful, rapid assessment and management of airway and ventilation are critical to preventing morbidity and mortality. Airway compromise can occur
More informationAirway/Breathing. Chapter 5
Airway/Breathing Chapter 5 Airway/Breathing Introduction Rapid assessment and management of airway and ventilation are critical to preventing morbidity and mortality. Airway compromise can occur rapidly
More informationI - Gel Versus Cuffed Tracheal Tube in Elective Laparoscopic Cholecystectomy A Clinical Comparative Study
Original Research I - Gel Versus Cuffed Tracheal Tube in Elective Laparoscopic Cholecystectomy A Clinical Comparative Study Siddharam Jamagond 1, Anuradha H 2, Ramesh.K 3 1 Senior resident, Department
More informationISSN X (Print) Research Article. *Corresponding author Dr. Souvik Saha
Scholars Journal of Applied Medical Sciences (SJAMS) Sch. J. App. Med. Sci., 2015; 3(6B):2238-2243 Scholars Academic and Scientific Publisher (An International Publisher for Academic and Scientific Resources)
More informationNursing General Essential ALS Classic SimMom* Anne Nursing Airway features Essential ALS Classic SimMom Anne
General 3G Essential ALS Classic SimMom* Nursing Late free Simulated patient monitor Runs pre programmed LLEAP scenarios Adult Male Female genitalia Female breasts Pre recorded vocal sounds Live vocal
More informationOverview. Chapter 37. Advanced Airway Techniques. Sellick Maneuver 9/11/2012
Chapter 37 Advanced Airway Techniques Slide 1 Sellick Maneuver Purpose Anatomic Location Technique Special Considerations Overview Advanced Airway Management of Adults Esophageal Tracheal Combitubes Tracheal
More informationWe will not be using the King LTS-D in our system!
King LT-D The King LT is a superior, disposable supraglottic airway tool that utilizes the latest technological advances in materials and design to provide the best nonintubating airway possible. The King
More informationOrotracheal Intubation
T h e n e w e ng l a nd j o u r na l o f m e dic i n e videos in clinical medicine Orotracheal Intubation Christopher Kabrhel, M.D., Todd W. Thomsen, M.D., Gary S. Setnik, M.D., and Ron M. Walls, M.D.
More informationDifficult Airway. Department of Anesthesiology University of Colorado Health Sciences Center (prepared by Brenda A. Bucklin, M.D.)
Difficult Airway Department of Anesthesiology University of Colorado Health Sciences Center (prepared by Brenda A. Bucklin, M.D.) Objectives Definition & incidence of the difficult airway Evaluation of
More informationProvision of General Anesthesia Out of Hospital: Perspective from The Americas. Anthony Charles Caputo
Provision of General Anesthesia Out of Hospital: Perspective from The Americas Anthony Charles Caputo Welcome!! A Little About Me President, Southwest Dental Anesthesia Services Past President, American
More informationAirway Management & Safety Concerns Experience from Bariatric Surgery
Airway Management & Safety Concerns Experience from Bariatric Surgery Issues of the Obese Critical Care Patient - Airway Srikantha Rao MBBS MS Associate Professor Department of Anesthesia Aug 2010 Objectives
More informationAirway Anatomy. Soft palate. Hard palate. Nasopharynx. Tongue. Oropharynx. Hypopharynx. Thyroid cartilage
Airway Anatomy Hard palate Soft palate Tongue Nasopharynx Oropharynx Hypopharynx Thyroid cartilage Airway Anatomy Hyoid bone Thyroid cartilage Cricoid cartilage Trachea Cricothyroid membrane Airway Anatomy
More informationThe reasons 13/11/ Cost 2. Availability 3. Comparison 4. Complications 5. Knowledge. Pulmonary and critical care medicine (PCCM) fellows.
The reasons Why shouldn t we use videolaryngoscope for routine intubation? Wariya Sukhupragarn, MD Associate Professor Department of Anesthesiology Faculty of Medicine, Chiang Mai University 1. Cost 2.
More informationPediatric Cardiac Arrest General
Date: November 15, 2012 Page 1 of 5 Pediatric Cardiac Arrest General This protocol should be followed for all pediatric cardiac arrests. If an arrest is of a known traumatic origin refer to the Dead on
More informationJefferson Tower Task Trainer List
Jefferson Tower Task Trainer List Table of Contents Blue Phantom Ultrasound Central Line Training Model 2 Blue Phantom Femoral Vascular Access Training Model 3 Blue Phantom Thoracentesis Ultrasound Training
More informationThis interdisciplinary clinical support document provides guidelines for the safe establishment of an artificial airway.
PURPOSE This interdisciplinary clinical support document provides guidelines for the safe establishment of an artificial airway. POLICY STATEMENTS Endotracheal intubation will be performed by the Most
More informationAnatomy and Physiology. The airways can be divided in to parts namely: The upper airway. The lower airway.
Airway management Anatomy and Physiology The airways can be divided in to parts namely: The upper airway. The lower airway. Non-instrumental airway management Head Tilt and Chin Lift Jaw Thrust Advanced
More informationI. Subject: Continuous Positive Airway Pressure CPAP by Continuous Flow Device
I. Subject: Continuous Positive Airway Pressure CPAP by Continuous Flow Device II. Policy: Continuous Positive Airway Pressure CPAP by the Down's system will be instituted by Respiratory Therapy personnel
More informationEmergency Department/Trauma Adult Airway Management Protocol
Emergency Department/Trauma Adult Airway Management Protocol Purpose: A standardized protocol for management of the airway in the setting of trauma in an academic center, with the goal of maximizing successful
More informationAirway Assessment for Office Sedation/ Anesthesia
CONTINUING EDUCATION IN HONOR OF NORMAN TRIEGER, DMD, MD Airway Assessment for Office Sedation/ Anesthesia Morton B. Rosenberg, DMD,* and James C. Phero, DMD *Professor of Oral Maxillofacial Surgery, Head,
More informationAirway Management and The Difficult Airway
Airway Management and The Difficult Airway Gary McCalla, MD, FACEP Medical Director REACH Air Medical Services Services 1 It is not enough to do your best, unless you have prepared to be the best. -John
More informationUse of the Intubating Laryngeal Mask Airway
340 Anesthesiology 2000; 93:340 5 2000 American Society of Anesthesiologists, Inc. Lippincott Williams & Wilkins, Inc. Use of the Intubating Laryngeal Mask Airway Are Muscle Relaxants Necessary? Janet
More informationADVANCED AIRWAY PROCEDURES
ADVANCED AIRWAY PROCEDURES This procedure includes the following: Endotracheal intubation (plus use of Supraglottic Airway Laryngopharyngeal Tube (S.A.L.T. device), gum elastic bougie assisted tracheal
More informationCapnography (ILS/ALS)
Capnography (ILS/ALS) Clinical Indications: 1. Capnography shall be used as soon as possible in conjunction with any airway management adjunct, including endotracheal, Blind Insertion Airway Devices (BIAD)
More informationAnesthetic challenges when elective case becomes emergent
Anesthetic challenges when elective case becomes emergent Shridevi Pandya Shah MD Asst Professor Dept of Anesthesiology Rutgers-NJMS Rutgers, The State University of New Jersey Conflicts of interest: none
More informationCricoid pressure: useful or dangerous?
Cricoid pressure: useful or dangerous? Francis VEYCKEMANS Cliniques Universitaires Saint Luc Bruxelles (2009) Controversial issue - Can J Anaesth 1997 JR Brimacombe - Pediatr Anesth 2002 JG Brock-Utne
More informationPre-Hospital Laryngeal Mask Airway Insertion Program Overview
Program Overview Program Title Student Eligibility Emergency Medical Technicians certified as Intermediates or Paramedics to perform endotracheal intubation in the Commonwealth of Massachusetts. Course
More informationCitation British journal of anaesthesia, 104. pp ; 2010 is available onlin
NAOSITE: Nagasaki University's Ac Title Laryngeal mask airway Supreme for a Author(s) Murata, Hiroaki; Nagaishi, Chikako; Citation British journal of anaesthesia, 104 Issue Date 2010-03 URL Right http://hdl.handle.net/10069/24856
More informationJoint Theater Trauma System Clinical Practice Guideline
Page 1 of 7 Joint Theater Trauma System Clinical Practice Guideline TRAUMA AIRWAY MANAGEMENT Original Release/Approval 18 Dec 2004 Note: This CPG requires an annual review. Reviewed: May 2012 Approved:
More informationMichigan General Procedures EMERGENCY AIRWAY. Date: November 15, 2012 Page 1 of 16
Date: November 15, 2012 Page 1 of 16 Emergency Airway Effective airway management and ventilation are important lifesaving interventions that all EMS providers must be able to perform. The approach to
More informationThe critique of the American Society Of Anesthesiologists. Difficult airway algorithm: a practical approach to the critical airway
The critique of the American Society Of Anesthesiologists. Difficult airway algorithm: a practical approach to the critical airway 225 Adrian A. Matioc Conflict of interests: Dr Adrian Matioc is the inventor
More informationUse of the Aintree Intubation Catheter with the Laryngeal Mask Airway and a Fiberoptic Bronchoscope in a Patient with an Unexpected Difficult Airway
Case Report Use of the Aintree Intubation Catheter with the Laryngeal Mask Airway and a Fiberoptic Bronchoscope in a Patient with an Unexpected Difficult Airway Andrew Zura MD, D. John Doyle MD PhD FRCPC,
More informationAngkana Lurngnateetape,, MD. Department of Anesthesiology Siriraj Hospital
AIRWAY MANAGEMENT Angkana Lurngnateetape,, MD. Department of Anesthesiology Siriraj Hospital Perhaps the most important responsibility of the anesthesiologist is management of the patient s airway Miller
More informationCAPNOGRAPHY. 1.1 To set forth the policy and procedure for performing continuous end-tidal waveform capnography.
OFFICE OF MEDICAL AFFAIRS DIRECTIVE 2009-02 CAPNOGRAPHY 1. PURPOSE 1.1 To set forth the policy and procedure for performing continuous end-tidal waveform capnography. 2. SCOPE 2.1 This procedure applies
More informationstudent handbook BARS handbook September 2012.indd Front Cover 27/11/12 12:08 PM
student handbook BARS handbook September 2012.indd Front Cover 27/11/12 12:08 PM All materials regarding the Basic Airway Resuscitation Strategy Course were written and developed by Dr. Richard Morris
More informationPreface... Acknowledgements... Contributors... 1 The Difficult Airway: Definitions and Algorithms The Expected Difficult Airway...
Contents Preface... Acknowledgements... Contributors... vii ix xvii 1 The Difficult Airway: Definitions and Algorithms... 1 Zdravka Zafirova and Avery Tung Introduction 1 Definitions 2 Incidence 3 Algorithms
More informationRapid Sequence Induction
Rapid Sequence Induction Virtual simultaneous administration, after preoxygenation, of a potent sedative agent and a rapidly acting neuromuscular blocking agent to facilitate rapid tracheal intubation
More informationDifficult Airway Management during Anesthesia: A Review of the Incidence and Solutions
Review Article imedpub Journals http://www.imedpub.com/ Journal of Anaesthesiology and Critical Care Difficult Airway Management during Anesthesia: A Review of the Incidence and Solutions Zhiyong Zeng
More informationAirway Management. Teeradej Kuptanon, MD
Airway Management Teeradej Kuptanon, MD Outline Anatomy Detect difficult airway Rapid sequence intubation Difficult ventilation Difficult intubation Surgical airway access ICU setting Intubation Difficult
More informationEmergency Cricothyrotomy
Emergency Cricothyrotomy SWORBHP Live Paramedic Rounds June 15, 2012 Sameer Mal PGY4 Emergency Medicine Dwayne Cottel Regional Paramedic Educator Overview BVM Ventilation Intro to Cricothyrotomy Relevant
More informationAll I need is an LMA
All I need is an LMA Narasimhan Sim Jagannathan, M.D. Associate Chairman, Academic Affairs Director, Pediatric Anesthesia Research Ann & Robert H. Lurie Children s Hospital of Chicago Associate Professor
More informationA Comparative Study of Two Disposable Supraglottic Devices in Diagnostic Laparoscopy in Gynecology
10.5005/jp-journals-10006-1243 Suman ORIGINAL Chattopadhyay, ARTICLESebanti Goswami A Comparative Study of Two Disposable Supraglottic Devices in Diagnostic Laparoscopy in Gynecology Suman Chattopadhyay,
More informationISPUB.COM. The Use of LMA in Newborn Resuscitation. R Vadhera INTRODUCTION VENTILATION
ISPUB.COM The Internet Journal of Anesthesiology Volume 1 Number 4 The Use of LMA in Newborn Resuscitation R Vadhera Citation R Vadhera. The Use of LMA in Newborn Resuscitation. The Internet Journal of
More information1 Pediatric Advanced Life Support Science Update What s New for 2010? 3 CPR. 4 4 Steps of BLS Survey 5 CPR 6 CPR.
1 Pediatric Advanced Life Support Science Update 2010 2 What s New for 2010? 3 CPR Take no longer than seconds for pulse check Rate at least on per minute (instead of around 100 per minute ) Depth change:
More informationOWN THE AIRWAY. Airway Management Bruce Barry, RN, CEN, CPEN, TCRN, NRP. Paramedic Program
OWN THE AIRWAY Airway Management Bruce Barry, RN, CEN, CPEN, TCRN, NRP The largest detriment to airway management has nothing to do with the patient, but everything to do with you as a provider. PRACTICE..PRACTICE.PRACTICE.
More informationORIGINAL ARTICLE. Shashank Chitmulwar, MD, Charulata Deshpande, MD, DA ABSTRACT. ANAESTHESIA, PAIN & INTENSIVE CARE
ORIGINAL ARTICLE ANAESTHESIA, PAIN & INTENSIVE CARE www.apicareonline.com Comparison of insertion characteristics between LMA- Supreme and Laryngeal tube with suction in patients undergoing short duration
More informationAll bedside percutaneously placed tracheostomies
Page 1 of 5 Scope: All bedside percutaneously placed tracheostomies Population: All ICU personnel Outcomes: To standardize and outline the steps necessary to safely perform a percutaneous tracheostomy
More informationH: Respiratory Care. Saskatchewan Association of Licensed Practical Nurses, Competency Profile for LPNs, 3rd Ed. 79
H: Respiratory Care Saskatchewan Association of Licensed Practical Nurses, Competency Profile for LPNs, 3rd Ed. 79 Competency: H-1 Airway Management H-1-1 H-1-2 H-1-3 H-1-4 H-1-5 Demonstrate knowledge
More informationTable 1: The major changes in AHA / AAP neonatal resuscitation guidelines2010 compared to previous recommendations in 2005
Table 1: The major changes in AHA / AAP neonatal guidelines2010 compared to previous recommendations in 2005 Resuscitation step Recommendations (2005) Recommendations (2010) Comments/LOE 1) Assessment
More informationRole of laryngeal mask airway in emergency department and pre-hospital environment
Hong Kong Journal of Emergency Medicine Role of laryngeal mask airway in emergency department and pre-hospital environment FKC Chu LMA and Intubating LMA (LMA-Fastrach) have been widely used by anesthesiologists
More informationDr.Bharghavi.M 2 nd year post graduate Dept of Anaesthesia
DIFFICULT AIRWAY CANNOT VENTILATE, CANNOT INTUBATE. Dr.Bharghavi.M 2 nd year post graduate Dept of Anaesthesia Difficult airway According to AMERICAN SOCIETY OF ANAESTHESIOLOGISTS Difficult Airway is defined
More informationPEMSS PROTOCOLS INVASIVE PROCEDURES
PEMSS PROTOCOLS INVASIVE PROCEDURES Panhandle Emergency Medical Services System SURGICAL AND NEEDLE CRICOTHYROTOMY Inability to intubate is the primary indication for creating an artificial airway. Care
More informationDomino KB: Closed Malpractice Claims for Airway Trauma During Anesthesia. ASA Newsletter 62(6):10-11, 1998.
Citation Domino KB: Closed Malpractice Claims for Airway Trauma During Anesthesia. ASA Newsletter 62(6):1-11, 18. Full Text As experts in airway management, anesthesiologists are at risk for liability
More informationDeposited on: 11 February 2010
Uppal, V. and Gangaiah, S. and Fletcher, G. and Kinsella, J. (2009) Randomized crossover comparison between the i-gel and the LMA- Unique in anaesthetized, paralysed adults. British Journal of Anaesthesia,
More informationHeartCode PALS. PALS Actions Overview > Legend. Contents
HeartCode PALS PALS Actions Overview > Legend Action buttons (round buttons) Clicking a round button initiates an action. Clicking this button, for example, checks the child s carotid pulse. Menu buttons
More informationPediatric Patients. BCFPD Paramedic Education Program. EMS Education Paramedic Level
Pediatric Patients BCFPD Program Basic Considerations Much of the initial patient assessment can be done during visual examination of the scene. Involve the caregiver or parent as much as possible. Allow
More information12/15/2010. Presented by: Jim Fox EMT-PS EMS-I EMS Assistant Coordinator Des Moines Fire Department
Presented by: Jim Fox EMT-PS EMS-I EMS Assistant Coordinator Des Moines Fire Department History Controversies Airway Management King Combi-Tube Easy Tube ETI Instructions for use Anatomy of King airway
More informationThe LMA CTrach TM, a new laryngeal mask airway for endotracheal intubation under vision: evaluation in 100 patients
British Journal of Anaesthesia 96 (3): 396 400 (2006) doi:10.1093/bja/ael001 Advance Access publication January 16, 2006 The LMA CTrach TM, a new laryngeal mask airway for endotracheal intubation under
More informationA randomised comparison between Cobra PLA and classic laryngeal mask airway and laryngeal tube during mechanical ventilation for general anaesthesia
ORIGINAL AND CLINICAL PAPERS Anaesthesiology Intensive Therapy 2013, vol. 45, no 1, 20 24 ISSN 1642 5758 DOI: 10.5603/AIT.2013.0004 www.ait.viamedica.pl A randomised comparison between Cobra PLA and classic
More informationEducational Session: Evaluation and Management of the Difficult Airway
Educational Session: Evaluation and Management of the Difficult Airway Diane M. Birnbaumer, MD, FACEP 3/24/2010 7:30 AM - 8:30 AM The Difficult Airway What s Up YOUR Sleeve? Diane M. Birnbaumer, M.D.,
More informationFinal Written Exam ASHI ACLS
Final Written Exam ASHI ACLS Instructions: Identify the choice that best completes the statement or answers the question. Questions 1 and 2 pertain to the following scenario: A 54-year-old man has experienced
More informationRandomised comparison of the LMA Supreme with the I-Gel in spontaneously breathing anaesthetised adult patients
Anaesth Intensive Care 2010; 38: Randomised comparison of the LMA Supreme with the I-Gel in spontaneously breathing anaesthetised adult patients E. F. F. CHEW*, N. HANEEM, C. Y. WANG Department of Anaesthesia,
More informationClearing the air.. How to assist and rescue neck breathing patients. Presented by: Don Hall MCD, CCC/SLP Sarah Markel RRT, MHA
Clearing the air.. How to assist and rescue neck breathing patients Presented by: Don Hall MCD, CCC/SLP Sarah Markel RRT, MHA Learning Objectives Define common terms identified with total (laryngectomy)
More informationScience Behind Resuscitation. Vic Parwani, MD ED Medical Director CarolinaEast Health System August 6 th, 2013
Science Behind Resuscitation Vic Parwani, MD ED Medical Director CarolinaEast Health System August 6 th, 2013 Conflict of Interest No Financial or Industrial Conflicts Slides: Drs. Nelson, Cole and Larabee
More informationBasic Airway Management
Basic Airway Management Dr. Madhurita Singh, Assoc. Professor, Dept. of Critical Care, CMC Vellore. This is the first module in a series on management of airway and ventilation in critically ill patients.
More informationDouble-lumen endotracheal tubes (DLTs) are used
Case Report 503 Tension Pneumothorax Complicated by Double-Lumen Endotracheal Tube Intubation Chia-Chun Huang, MD; An-Hsun Chou, MD; Hung-Pin Liu, MD; Chee-Yueu Ho, MD; Min-Wein Yun, MD Tension pneumothorax
More informationThey aren t the same thing. Daniel Dunham
They aren t the same thing Daniel Dunham Capnometry Displays the value (as a number) of the partial pressure of CO2 Capnography Waveform capnography shows (as a wave) the change in CO2 over time Both are
More informationDon t let your patients turn blue! Isn t it about time you used etco 2?
Don t let your patients turn blue! Isn t it about time you used etco 2? American Association of Critical Care Nurses National Teaching Institute Expo Ed 2013 Susan Thibeault MS, CRNA, APRN, CCRN, EMT-P
More informationAdvanced cardiovascular life support (ACLS) impacts multiple
Part 8: Adult Advanced Cardiovascular Life Support 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Robert W. Neumar, Chair; Charles W. Otto;
More informationDisclosures. Learning Objectives. Coeditor/author. Associate Science Editor, American Heart Association
Tracheotomy Challenges for airway specialists Elizabeth H. Sinz, MD Professor of Anesthesiology & Neurosurgery Associate Dean for Clinical Simulation Disclosures Coeditor/author Associate Science Editor,
More informationSuper Info about SupraGlottics JOE HOLLEY SCOTT YOUNGQUIST JON JUI
Super Info about SupraGlottics JOE HOLLEY SCOTT YOUNGQUIST JON JUI How well do supraglottic devices seal the airway? Effect of the ITD on Intracranial and Cerebral Perfusion Pressures Standard CPR ACD
More informationA prospective randomized study comparing the efficacy of the LMA Classic TM, the
Original Research Article A prospective randomized study comparing the efficacy of the LMA Classic TM, the AMBU Aura40 Laryngeal Mask TM and the I-Gel TM using fiberoptic bronchoscope in spontaneously
More informationHow do you use a bougie as an airway adjunct for endotracheal intubation?
Ruth Bird, MBBCh -Specialist Registrar: Anaesthesia & Paediatric Trauma Fellow Daniel Nevin, MBBCh -Consultant in Anaesthesia & Pre-Hospital Care The Royal London Hospital London s Air Ambulance (HEMS)
More informationINTUBATION/RSI. PURPOSE: A. To facilitate secure, definitive control of the airway by endotracheal intubation in an expeditious and safe manner
Manual: LifeLine Patient Care Protocols Section: Adult/Pediatrics Protocol #: AP1-009 Approval Date: 03/01/2018 Effective Date: 03/05/2018 Revision Due Date: 12/01/2018 INTUBATION/RSI PURPOSE: A. To facilitate
More informationThe Pediatric Patient. Morgen Bernius, MD NCEMS Conference February 24, 2007
The Pediatric Patient Morgen Bernius, MD NCEMS Conference February 24, 2007 Rule #1: Everyone Loves the Pediatric Patient Pediatrics in EMS Approximately 10% of all EMS treatment is for children younger
More informationHanna K. Al-Makhamreh, M.D., FACC Interventional Cardiologist
Hanna K. Al-Makhamreh, M.D., FACC Interventional Cardiologist Introduction. Basic Life Support (BLS). Advanced Cardiac Life Support (ACLS). Cardiovascular diseases (CVDs) are the number one cause of death
More informationJay B. Brodsky, M.D. Professor Department of Anesthesia tel: (650) Stanford University School of Medicine fax: (650)
Jay B. Brodsky, M.D. Professor Department of Anesthesia tel: (650) 725-5869 Stanford University School of Medicine fax: (650) 725-8544 Stanford, CA, 94305, USA e-mail: jbrodsky@stanford.edu RELIABLE SEPARATION
More information